Trigeminal neuralgia and migraines are conditions known for causing severe, life-impacting pain. Although they are distinct disorders, they sometimes share common pathways and sometimes occur together. Trigeminal neuralgia can cause sudden, electric shock-like facial pain, often triggered by everyday activities such as talking or chewing. Migraines, on the other hand, are episodes of intense, throbbing headache that may last for hours or even days, often accompanied by nausea and sensitivity to light or sound.
Managing these conditions implies more than just taking painkilling medications. Understanding how these disorders are connected is crucial for developing more effective, targeted treatments. At Centeno-Schultz Clinic, our goal is to go beyond symptom management and address the root cause of pain to support long-lasting relief and improved quality of life.
Trigeminal Nerve As A Shared Pathway
The trigeminal nerve is a major cranial nerve that stems from the base of the brain and splits into three main branches: the ophthalmic, maxillary, and mandibular nerves. These branches carry sensory information—such as pain, temperature, and touch—from the scalp, forehead, cheeks, jaw, teeth, and gums to the brain and vice-versa. It also controls key muscles involved in chewing and jaw movement.
Because the trigeminal nerve processes most head and facial sensations, it is often a major player in various pain conditions:
- Trigeminal Neuralgia: This is a nerve condition that occurs when the trigeminal nerve becomes compressed, irritated, or damaged. This can happen due to physical compression from tissue growths, such as tumors, or nearby arteries. Compression and irritation interfere with the nerve’s ability to relay signals, causing it to misfire and send intense, sudden pain signals often described as sharp, electric shocks.
- Migraine: A migraine is a neurological condition that causes intense, throbbing pain, often on one side of the head. Unlike other headaches, the pain results from abnormal brain activity that affects nerves, blood vessels, and bodily chemicals. Triggers vary and may involve the trigeminal nerve’s pain pathways.
Recent research shows that trigeminal neuralgia and migraines are often connected, with evidence supporting a meaningful overlap between the two conditions. Research has found that people with migraines are 6 times more likely to develop trigeminal neuralgia than those without migraines.[1]
Comparing Trigeminal Neuralgia And Migraine
Trigeminal neuralgia and migraines are both serious neurological disorders that can cause severe facial or head pain. While some of their symptoms and contributing factors may overlap, they have different causes and patterns.
Understanding the signs of each and their differences is crucial for obtaining the correct diagnosis and finding effective treatment. The table below highlights the key differences and similarities between trigeminal neuralgia and migraines.
Trigeminal NeuralgiaSymptom CharacteristicMigraine
Sudden, sharp, stabbing, or electric shock-like painType of PainThrobbing or pulsing pain that is often severe
Very brief, lasting from a few seconds up to two minutes per episodeDuration of AttackLonger-lasting, typically from 4 to 72 hours if untreated
Almost always on one side of the face, often along the cheek, jaw, or foreheadLocation of PainOften on one side of the head, but it can affect the entire head, face, or neck
Light touch to the face, chewing, talking, brushing teeth, or a cool breezeCommon TriggersHormonal changes, stress, certain foods/drinks, bright lights, loud sounds, or changes in sleep
Facial twitching or spasms can occur during an attackAssociated SymptomsNausea, vomiting, extreme sensitivity to light and sound, or visual disturbances (aura) before the headache
How Your Neck Can Trigger Both Conditions
The area where the neck meets the base of the skull is known as the upper cervical spine. This area includes the first two vertebrae, specifically C1 (the atlas) and C2 (the axis), which play a crucial role in supporting the head and maintaining neck mobility. The cervical spine is also where many nerve roots exit the spine to supply sensory and motor information to other parts of the upper body, such as the head and face.
The C1-C2 bones become loose or unstable due to injury, malformations, weakened muscles, or conditions such as arthritis. When this happens, the abnormal motion can irritate nerves, including the trigeminal nerve, that stem from this area.[2][3] This can contribute to migraines and trigeminal neuralgia.
When Recurring Head and Facial Pain Signals Underlying Cause
Head and facial pain that recurs or does not respond to conventional treatments often indicates an underlying problem. Structural issues in the neck, jaw, nerves, or even beyond can mimic or worsen symptoms of trigeminal neuralgia and migraines.
Common overlapping or related conditions include:
- Temporomandibular Joint Dysfunction (TMJ): TMJ dysfunction involves problems with the jaw joint and surrounding muscles. Misalignment or clenching can irritate nerves and cause muscle tightness, leading to jaw and facial pain, clicking, and headaches.
- Cervicogenic Headache: This type of headache originates in the neck and radiates to the head, typically due to problems with the joint, muscle, or nerves in the upper cervical spine.
- Occipital Neuralgia: Occipital neuralgia is irritation of the occipital nerves at the back of the head, causing stabbing or shock-like pain that can radiate to the scalp, forehead, and eyes. This pain indicates the compression of a nerve in the upper neck or skull base, which can affect the occipital nerves as well as the brainstem, where the trigeminal nerve originates.
- Cluster Headache: These severe headaches occur in recurring episodes and can last from weeks to months. The pain is usually felt around one eye. They are linked to abnormalities in certain nerve pathways that are also shared with the trigeminal system. This may lead to overlapping symptoms, like facial pain.
- Sinus-Related Pain or Sinusitis: Inflammation or infection in the sinus cavities can create a pressure-like, throbbing pain in the face or forehead. Swollen sinuses may press on branches of the trigeminal nerve, leading to facial pain similar to migraine or TN.
- Bruxism: Clenching or grinding the teeth, often at night, strains jaw muscles and joints. This ongoing stress can inflame nerves in the jaw and face, triggering headache or facial pain.
- Post-Herpetic Neuralgia: This refers to ongoing nerve pain that develops after a shingles infection, sometimes impacting the trigeminal nerve. This can lead to lasting burning or stabbing sensations in the face.
- Multiple Sclerosis (MS): MS damages the protective coating (myelin) around nerves in the brain and spinal cord. Demyelination of the trigeminal nerve or nearby pathways can lead to facial pain. MS is a recognized risk factor for trigeminal neuralgia, with research showing that about 15% of people diagnosed with TN are later found to have MS, while up to 3.4% of those living with MS may experience TN.[4][5]
Reaching An Accurate And Comprehensive Diagnosis
Achieving lasting relief from head and facial pain begins with pinpointing its true underlying causes. Accurate diagnosis is crucial because symptoms of trigeminal neuralgia, migraine, and related conditions often overlap. Additionally, standard diagnostic tools can miss the structural issues that contribute to recurring pain.
A comprehensive diagnosis combines patient history, physical assessment, and advanced imaging to map out exactly where pain originates and how it is triggered.
Patient History And Physical Examination
Your physician will review the nature and frequency of your symptoms, including when pain episodes began, their triggers, intensity, and duration.
During this examination, a physician will also evaluate your medical history, jaw and neck health, sleep patterns, and any previous injuries or dental work. They may also look for areas of tenderness, test nerve function, and evaluate muscle strength and joint mobility.
This physical exam is a key starting point to help identify underlying causes of head and facial pain, rule out other conditions, and guide recommendations for further tests or treatment options.
Review Of Cervical Spine MRI
An MRI of the cervical spine provides detailed pictures of the bones, discs, and soft tissues in your neck. This scan helps reveal anatomical issues, such as herniated discs, arthritis, or alignment problems, that may be compressing or irritating the nerves connected to the head and face.
Functional And Dynamic Imaging
Traditional imaging techniques, such as MRI or standard X-rays, provide static images of the body. This means they can miss problems that only become visible during movement.
However, many nerve and joint problems—especially those in the neck and jaw—occur or become more apparent only when these structures are in motion. Without imaging that captures the body during movement, these dynamic issues may go unnoticed and untreated.
Functional and dynamic imaging tests fill this gap to provide a more comprehensive assessment:
- Musculoskeletal ultrasound: This imaging technique uses sound waves to visualize soft tissues and joints as they move. It allows your physician to assess muscles, ligaments, and nerve gliding during jaw or neck movement, helping identify hidden areas of compression or instability that may trigger pain.
- Digital Motion X-ray (DMX): DMX is a specialized, real-time X-ray technique that captures dynamic images of the cervical spine and skull in motion. Unlike static imaging, DMX highlights instabilities, such as abnormal movement of C1 and C2 vertebrae in the neck or changes in how ligaments function. These issues, which can be significant contributors to facial pain, are often missed by traditional scans. Recent research shows DMX can achieve exceptional accuracy in detecting cases of cranio-cervical instability by measuring the degree of bone movement relative to one another as you tilt or turn your head.
Exploring Common Approaches To Relief And Management
There is no single solution that works for everyone with trigeminal neuralgia, migraines, or related head and neck pain. Care plans must be customized for each individual and their specific diagnosis to be effective. Successful treatment plans often combine medical, physical, and lifestyle strategies aimed at reducing pain, improving function, and helping patients avoid long-term medication or unnecessary surgery.
- Medications: Certain medications may help control nerve activity, reduce pain signaling, or decrease inflammation. These include anti-seizure medications for TN, triptans or beta-blockers for migraine, and pain relievers or antidepressants for associated nerve pain.
- Physical Therapy: Physician-guided exercises, manual therapy, and nerve mobilization techniques reduce muscle tension and improve posture. They may also help address structural problems in the jaw, neck, or head that may trigger symptoms.
- Procedural Treatments: Minimally invasive procedures, such as nerve blocks, Botox injections, PRP therapy, or targeted neurostimulation, can calm irritated nerves and support nerve health.
- Lifestyle and Self-Care Approaches: Making changes in daily routines can help control symptoms and prevent flare-ups. Suggested recommendations include improving posture, managing screen time, pacing activities and taking breaks, and using special cushions.
- Stress Management: Techniques such as biofeedback, mindfulness, relaxation, and counseling help calm the nervous system and reduce stress, which may be a contributor to pain episodes.
- Sleep Hygiene: Deep, restful sleep helps regulate brain chemicals and pain pathways involved in migraines and nerve pain. Disrupted or poor sleep can increase fatigue and stress, and even trigger attacks.
- Diet: Certain foods can act as triggers for migraines and pain. Identifying and avoiding these foods, staying hydrated, and following a balanced diet can help lower the risk of flare-ups.
- Ergonomic Adjustments: Adjusting workspaces, using supportive pillows, or modifying daily activities to minimize strain on the neck and jaw.
Work With Physicians On Care That Targets The Right Condition
Diagnosing and treating complex neurological conditions like trigeminal neuralgia and migraines requires a high level of expertise and advanced tools. At the Centeno-Schultz Clinic, our board-certified physicians have specialized training in both neurological and musculoskeletal disorders, allowing them to assess not only nerve health but also how joint, ligament, or muscle problems in the neck or jaw may contribute to symptoms.
We use advanced diagnostic tools, including digital motion X-ray (DMX), musculoskeletal ultrasound, and high-resolution MRI, to pinpoint the exact sources of pain. This thorough diagnosis is essential for informing treatment decisions, which may include regenerative therapies, such as PRP injections or evidence-based approaches like the IGNIte procedure.
The IGNIte procedure is a non-surgical alternative to treat trigeminal neuralgia using image-guided platelet lysate (PL) injections around the branches of the trigeminal nerve to deliver concentrated growth factors derived from the patient’s own blood. We utilize image-guidance with fluoroscopy to ensure safety and accuracy. The goal of the procedure is to stimulate natural nerve repair and reduce local inflammation without ablating or cutting the nerve.This can reduce pain and alleviate the symptoms of trigeminal neuralgia.
Lasting Relief Starts With The Right Diagnosis
Long-term relief from head and facial pain, migraines, or trigeminal neuralgia begins with a careful, accurate diagnosis. At the Centeno-Schultz Clinic, the focus is on identifying the true cause of your symptoms using the latest diagnostic technology and a thorough clinical approach.
With these insights, our physicians will design a care plan tailored to your unique needs, aiming to offer you lasting improvement—without resorting to unnecessary medication or surgery.
Do your symptoms of facial pain and headaches point to a problem in your neck? Learn more about how we diagnose the root cause.
Sources
- Lin K-H, Chen Y-T, Fuh J-L, Wang S-J. Increased risk of trigeminal neuralgia in patients with migraine: A nationwide population-based study. Cephalalgia. 2015;36(13):1218-1227. doi:10.1177/0333102415623069
- Mańczak M, Gasik R. Cervical spine instability in the course of rheumatoid arthritis – imaging methods. Reumatologia. 2017;55(4):201-207. doi: 10.5114/reum.2017.69782. Epub 2017 Aug 31. PMID: 29056776; PMCID: PMC5647537.
- Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA. Trigeminal Neuralgia Commonly Precedes the Diagnosis of Multiple Sclerosis. Int J MS Care. 2017 Sep-Oct;19(5):240-246. doi: 10.7224/1537-2073.2016-065. PMID: 29070964; PMCID: PMC5649347.
- Prevalence of trigeminal neuralgia in multiple sclerosis: A systematic review and meta-analysis. Houshi, Shakiba et al. Multiple Sclerosis and Related Disorders, Volume 57, 103472
